GASTROINTESTINAL

Embryo

GI development
Foregut pharynx to duodenum
Midgut duodenum to proximal 2/3rd of transverse
colon
Hindgut distal 1/3rd of transverse colon to anal
canal above pectinate line
Duodenal atresia failure to recanalize (trisomy 21)
Jejunal, ileal, colonic atresia due to vascular
accident (apple peel atresia)
Midgut development:
6th week midgut herniates through umbilical ring
10th week returns to abdominal cavity + rotates around
SMA

Dis-development
Gastrochisis extrusion of
abdominal contents through
abdominal folds; not covered by
peritoneum
Omphalocele persistence of
herniation of abdominal contents into
umbilical cord; covered by
peritoneum

Anomalies
Esophageal atresia
drooling, choking, and vomiting with first
feeding.
Allows air to enter stomach (visible on CXR).
Cyanosis secondary to laryngospasm

Congenital pyloric stenosis

Hypertrophy of the pylorus causes
obstruction
Palpable olive mass in epigastric region
Nonbilous-projectile vomiting

Pancreas and spleen

embryo
Pancreas derived from the foregut
Annular pancreas ventral pancreatic bud
abnormally encircles 2nd part of duodenum,
forming a ring of pancreatic tissue that may
cause duodenal narrowing
Pancreas divisum ventral and dorsal parts
fail to fuse at 8 weeks

Spleen arises in mesentery of stomach,

but supplied by celiac artery in the
foregut

Anatomy

Retroperitoneal strictures
SAD PUCKER
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum
Pancreas
Ureters
Colon
Kidneys
Esophagus
Rectum

Physiology

CHOLECYSTOKININ

I cells (Duodenum, Jejunum)

Action

1.
2.
3.
4.

pancreatic secretions
gallbladder contraction
gastric emptying
relaxtion in sphincter of
Oddi

Regulation
. fatty acids, amino acids
GASTRIN

G cells (antrum of stomach)

Action

1.
2.
3.
4.

Regulation

. by stomach pH falling below

1.5

gastric H+ secretion
growth of mucosa
gastric motility
through stomach distention,
vagal stimulation

GLUCOSE-DEPENDENT
INSULINOTROPIC PEPTIDE
(GIP)
Action

K cells (duodenum,
jejunum)
1. insulin release
2. gastric secretions

Regulation

. fatty acids, amino acids,

oral glucose

MOTILIN

Small intestine

Action

1. Produces migrating motor

complexes (they produce
electric waves that trigger
persistalsis)
Motilin agonists (erythromycin)
used in stimulating intestinal
peristalsis

Regulation

. in fasting state

SECRETIN

S cells (duodenum)

Action

1. pancreatic Bicarbonate
secretion
2. gastric acid secretion
3. bile secretion

Regulation
. by fatty acids, and acid in
stomach
SOMATOSTATIN

D cells (pancratic islets, GI

mucosa)

Action
1. gastric acid secretion and
pepsinogen secretion
2. gallbladder contraction
3. insulin and glucagon release
Regulation
. by acid
. by vagal stimulation

INTRINSIC FACTOR

Parietal cells (stomach)

Action

1. Vitamin B12-binding
protein (require for B12
uptake in ileum)
2. Autoimmune destruction of
parietal cells is called
Pernicious anemia

GASTRIC ACID (HCl)

Parietal cells (stomach)

Action

1. stomach pH

Regulation

. By histamine, Ach, gastrin

. By somatostatin, GIP, Pges,
secretin

PEPSIN

Chief cells (stomach)

Action

1. Protein digestion

Regulation

. vagal stimulation, local

acid

HCO3 (BICARBONATE)

Mucosal cells (stomach,

duodenum, salivary glands,
pancreas), Brunner glands
(duodenum)
HCO3 is trapped in mucosa
that covers gastric epithelium

Action
1. Neutralizes acid
Regulation
. by pancreatic and biliary
secretion with secretin

Pancreatic secretions
Amylase Starch digestion
Lipase, phospholipase, colipase
Fat digestion
Proteases (trypsin, chymotrupsin,
elastase, carboxypeptidases) Protein
digestion
Trypsinogen converted to active
enzyme by trypsin (look above) by
enterokinase

CARB ABSORPTION
Glucose, galactose, fructose
absorption by enterocytes.
Transported to blood by GLUT-2
Glucose and galactose by SGLTI
Fructose taken up by facilitated
diffusion by GLUT-5

Vitamin/mineral absorption
Iron absorbed by Fe2+ in
duodenum
Folate absorbed in the jejunum
and ileum
B12 absorbed in terminal ileum
along with bile acids (intrinsic factor
required)

Peyer patches
In ileum
NOT encapsulated by lymphoid tissue
Found in lamina propria and submucosa of
ileum
Contain specialized M cells that sample and
present antigens to immune cells
B cells stimulated in germinal centers of
Peyer patches differentiate into IgA secreting
plasma cells
IgA receives protective secretory component

Bile
Composed of bile salts (conjugated to glycine
or taurine), phospholipids, cholesterol,
bilirubin, water, and ions
Chplesterol 7-hydroxylase cataluzes rate
limiting step of bile synthesis
Functions:
Digestion and absorption of lipids and fat-soluble
vitamins
Cholesterol excretion (bodys only means of
eliminating cholesterol)
Antimicrobial activity (membrane disruption)

Bilirubin
Product of heme metabolism
Bilirubin is removed from blood by
liver, conjugated with glucuronate,
and excreted in bile
Direct bilirubin conjugated with
glucuronic acid (water soluble)
Indirect bilirubin unconjugated, water
insoluble

Pathology